CHILDREN'S SWIMMING & DIVING LESSONS
CHILDREN’S SWIMMING & DIVING LESSONS sponsored by
Smith College Swimming and Diving Team Lessons: Saturday - 10:45-11:30 am (Recreational swim 11:30am – 12:00 pm) Site: Dalton Pool Ainsworth Gym, Smith College Dates: Sept 17, 24, Oct 1, 15, 22 Ages: 6 and up Cost: $55 checks payable to Smith College NO more than 4-5 students per instructor; students will be grouped by skill level Springboard diving group limited to 6 or 8 depending on age/skill of students with 1 or 2 instructors as dictated by the number of interested diving students Registration Limited (postmark/receipt – first submitted; first admitted) INFORMATION: Kim Bierwert 585-2722; email: [email protected] Send Registration as soon as possible to: SEE BELOW Notifications made by September 13 if registration is NOT ACCEPTED due to space limitations.
______ ____ ________________________________ REGISTRATION FORM – one per child SPRINGBOARD SWIMMING DIVING
AGE NAME: SWIMMING SKILLS: check if child can do the listed skill for swimming class instruction only: FACE IN WATER __ BLOW BUBBLES __ KICK ON WALL __ FLOAT ON FRONT WITHOUT ASSISTANCE __ KICK ON FRONT WIHTOUT ASSISTANCE __ FLOAT ON BACK WITHOUT ASSISTANCE __ KICK ON BACK WITHOUT ASSISTANCE __ SWIM ON FRONT WITH FACE IN THE WATER UP TO 5 FEET __ SWIM ON FRONT AND BREATHE WITHOUT STOPPING FOR 10-15 FEET __ JUMP IN TO WATER WITHOUT ASSISTANCE __ PERFORM ROTARY BREATHING ON FRONT CRAWL __ SWIM ON FRONT FOR ONE LENGTH (75 FEET) OF POOL__ SWIM ON BACK FOR 10-15 FEET __ SWIM BACKSTROKE FOR ONE LENGTH (75 FEET) OF POOL __ SWIM A FORM OF BREASTSTROKE ____ SWIM A FORM OF BUTTERFLY ___ DIVING SKILLS FOR SPRINGBOARD DIVING: check what child can do STANDING DIVE OFF EDGE __ STANDING DIVE OFF BOARD ___ FORWARD APPROACH ____ FRONT DIVE WITH APPROACH ___ BACK DIVE ___ FRONT SOMERSAULT (SS) __ BACK SS __ INWARD DIVE __ FRONT 1 1 /2 ___ TWISTING DIVE ___ OTHER _________________________ PARENTS NAME: ADDRESS: TEL: EMAIL:
Send Registration, Waiver and Check to: checks payable to Smith College Kim Bierwert, Ainsworth Gym, Smith College, Northampton, MA 01063 NOTE: Total Registration Limited - postmark/receipt
SMITH COLLEGE Release of Liability / Assumption of Risk / Agreement not to Sue Read this Release, Assumption of Risk, and Agreement not to Sue (this “Release”) carefully and in its entirety. It is a binding legal document. After reading this Release, sign your name, to show that you agree to and do assume all risks associated with your child's participation in this Program and that you release SMITH COLLEGE, its employees, trustees, officers, students, volunteers and representatives (the “College”) of any and all liability resulting from your child's participation in this Program. I, as the parent/guardian of the child named below, permit my child to participate in the Smith College Swimming & Diving Lessons described on the information flyer. I understand what the Program activities will be and give full approval for my child’s participation in the Program. I acknowledge that my child may be exposed to hazards and I voluntarily agree to assume all risks. I understand that the risks of the Program may include loss, injury, death or property damage caused by accident or illness, the forces of nature, and travel by automobile, bus or other vehicle or other hazards that are unknown. In consideration of my child’s participation in the Program, I hereby, now and forever release the College from and against any causes of action, claims or demands of any nature that may result from or be connected in any way to my child’s participation in the Program (“Claims”). I further agree not to sue and agree to indemnify and hold harmless the College from any Claims. It is also my express intent that this Release shall bind my spouse, family members, heirs, guardians, legal representatives, and assigns. I expressly agree that this Release shall be governed by and interpreted in accordance with the laws of the Commonwealth of Massachusetts. I intend this to be a complete and unconditional release of all liability to the greatest extent allowed by law. My child has been told the rules of the Program and agrees to follow them. We understand that he or she (my child) may be asked to leave the Program if the rules or the instructions are disobeyed. Medical Treatment Authorization I authorize the College to act on my behalf in any medical emergency as may be necessary. Media Release I understand and agree that the program and its participants may be recorded in any media and that the College may use or keep said recordings for any purpose. By signing below, I hereby confirm that I am the Parent or Legal Guardian for the Participant enrolled in the Program and that I have read this document in its entirety, understand it, and sign it voluntarily. Child’s Name: ___________________________________________ Month/Year of Birth: _________________ Signature of Parent/Legal Guardian __________________________________________ Date_______________ Print Name: ________________________________________________________________________________ Address: ____________________________________________ Telephone Number: ____________________ Emergency Contact Number/s or info: ___________________________________________________________ Other Information (e.g., allergies, physical limitations, etc.) __________________________________________ __________________________________________________________________________________________
THIS MUST BE SUBMITTED WITH THE SWIMMING/DIVING REGISTRATION FORM.
Program Information Name of Program __Children’s Swimming & Diving Lessons_____________________________________ Date/s of Program _9/17, 24; 10/1, 15, 22_________________________________________________ Start Time _10:45 am________________________ End Time 1:30 am_______________________ Program Manager __Kim Bierwert__________________ Phone _413-585-2722_______________ Emergency contact information for Program _Pool Deck Phone during the lessons__413-585-7595 Use this if you need to reach the program manager during the lessons because of an emergency. Drop off/ Pick up instructions: Children should be brought to Ainsworth Gym and enter the building on the parking lot level. The lockers rooms are on this level and provide access to the pool area. Children should be picked up after the lessons are over or after the recreational swim 11:30-12:00 based on your choice on participation in the recreational swim. Activities: Children will be instructed in swimming and/or diving skills based on their abilities. Participation requirements Children must be at least 6 yrs of age. Program Rules Children must follow all pool rules (no running on the deck, no diving in the shallow end, no horseplay, etc….) You are responsible to provide Children should bring a swim suit and towel. Goggles for swimming are at the option of the participant Parents may watch the lessons from the pool gallery or from the pool deck. We ask that parent s do not get involved in the lessons.
Please complete and sign the Release Form and submit it with your registration form. Applicants will not be accepted without a completed, signed form. We recommend that you keep a copy of this form for your records.
Smith College Swimming and Diving Team Lessons: Saturday - 10:45-11:30 am (Recreational swim 11:30am – 12:00 pm) Site: Dalton Pool Ainsworth Gym, Smith College Dates: Sept 17, 24, Oct 1, 15, 22 Ages: 6 and up Cost: $55 checks payable to Smith College NO more than 4-5 students per instructor; students will be grouped by skill level Springboard diving group limited to 6 or 8 depending on age/skill of students with 1 or 2 instructors as dictated by the number of interested diving students Registration Limited (postmark/receipt – first submitted; first admitted) INFORMATION: Kim Bierwert 585-2722; email: [email protected] Send Registration as soon as possible to: SEE BELOW Notifications made by September 13 if registration is NOT ACCEPTED due to space limitations.
______ ____ ________________________________ REGISTRATION FORM – one per child SPRINGBOARD SWIMMING DIVING
AGE NAME: SWIMMING SKILLS: check if child can do the listed skill for swimming class instruction only: FACE IN WATER __ BLOW BUBBLES __ KICK ON WALL __ FLOAT ON FRONT WITHOUT ASSISTANCE __ KICK ON FRONT WIHTOUT ASSISTANCE __ FLOAT ON BACK WITHOUT ASSISTANCE __ KICK ON BACK WITHOUT ASSISTANCE __ SWIM ON FRONT WITH FACE IN THE WATER UP TO 5 FEET __ SWIM ON FRONT AND BREATHE WITHOUT STOPPING FOR 10-15 FEET __ JUMP IN TO WATER WITHOUT ASSISTANCE __ PERFORM ROTARY BREATHING ON FRONT CRAWL __ SWIM ON FRONT FOR ONE LENGTH (75 FEET) OF POOL__ SWIM ON BACK FOR 10-15 FEET __ SWIM BACKSTROKE FOR ONE LENGTH (75 FEET) OF POOL __ SWIM A FORM OF BREASTSTROKE ____ SWIM A FORM OF BUTTERFLY ___ DIVING SKILLS FOR SPRINGBOARD DIVING: check what child can do STANDING DIVE OFF EDGE __ STANDING DIVE OFF BOARD ___ FORWARD APPROACH ____ FRONT DIVE WITH APPROACH ___ BACK DIVE ___ FRONT SOMERSAULT (SS) __ BACK SS __ INWARD DIVE __ FRONT 1 1 /2 ___ TWISTING DIVE ___ OTHER _________________________ PARENTS NAME: ADDRESS: TEL: EMAIL:
Send Registration, Waiver and Check to: checks payable to Smith College Kim Bierwert, Ainsworth Gym, Smith College, Northampton, MA 01063 NOTE: Total Registration Limited - postmark/receipt
SMITH COLLEGE Release of Liability / Assumption of Risk / Agreement not to Sue Read this Release, Assumption of Risk, and Agreement not to Sue (this “Release”) carefully and in its entirety. It is a binding legal document. After reading this Release, sign your name, to show that you agree to and do assume all risks associated with your child's participation in this Program and that you release SMITH COLLEGE, its employees, trustees, officers, students, volunteers and representatives (the “College”) of any and all liability resulting from your child's participation in this Program. I, as the parent/guardian of the child named below, permit my child to participate in the Smith College Swimming & Diving Lessons described on the information flyer. I understand what the Program activities will be and give full approval for my child’s participation in the Program. I acknowledge that my child may be exposed to hazards and I voluntarily agree to assume all risks. I understand that the risks of the Program may include loss, injury, death or property damage caused by accident or illness, the forces of nature, and travel by automobile, bus or other vehicle or other hazards that are unknown. In consideration of my child’s participation in the Program, I hereby, now and forever release the College from and against any causes of action, claims or demands of any nature that may result from or be connected in any way to my child’s participation in the Program (“Claims”). I further agree not to sue and agree to indemnify and hold harmless the College from any Claims. It is also my express intent that this Release shall bind my spouse, family members, heirs, guardians, legal representatives, and assigns. I expressly agree that this Release shall be governed by and interpreted in accordance with the laws of the Commonwealth of Massachusetts. I intend this to be a complete and unconditional release of all liability to the greatest extent allowed by law. My child has been told the rules of the Program and agrees to follow them. We understand that he or she (my child) may be asked to leave the Program if the rules or the instructions are disobeyed. Medical Treatment Authorization I authorize the College to act on my behalf in any medical emergency as may be necessary. Media Release I understand and agree that the program and its participants may be recorded in any media and that the College may use or keep said recordings for any purpose. By signing below, I hereby confirm that I am the Parent or Legal Guardian for the Participant enrolled in the Program and that I have read this document in its entirety, understand it, and sign it voluntarily. Child’s Name: ___________________________________________ Month/Year of Birth: _________________ Signature of Parent/Legal Guardian __________________________________________ Date_______________ Print Name: ________________________________________________________________________________ Address: ____________________________________________ Telephone Number: ____________________ Emergency Contact Number/s or info: ___________________________________________________________ Other Information (e.g., allergies, physical limitations, etc.) __________________________________________ __________________________________________________________________________________________
THIS MUST BE SUBMITTED WITH THE SWIMMING/DIVING REGISTRATION FORM.
Program Information Name of Program __Children’s Swimming & Diving Lessons_____________________________________ Date/s of Program _9/17, 24; 10/1, 15, 22_________________________________________________ Start Time _10:45 am________________________ End Time 1:30 am_______________________ Program Manager __Kim Bierwert__________________ Phone _413-585-2722_______________ Emergency contact information for Program _Pool Deck Phone during the lessons__413-585-7595 Use this if you need to reach the program manager during the lessons because of an emergency. Drop off/ Pick up instructions: Children should be brought to Ainsworth Gym and enter the building on the parking lot level. The lockers rooms are on this level and provide access to the pool area. Children should be picked up after the lessons are over or after the recreational swim 11:30-12:00 based on your choice on participation in the recreational swim. Activities: Children will be instructed in swimming and/or diving skills based on their abilities. Participation requirements Children must be at least 6 yrs of age. Program Rules Children must follow all pool rules (no running on the deck, no diving in the shallow end, no horseplay, etc….) You are responsible to provide Children should bring a swim suit and towel. Goggles for swimming are at the option of the participant Parents may watch the lessons from the pool gallery or from the pool deck. We ask that parent s do not get involved in the lessons.
Please complete and sign the Release Form and submit it with your registration form. Applicants will not be accepted without a completed, signed form. We recommend that you keep a copy of this form for your records.
